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SAN .JOAQUIN Environmel Health Department <br /> —COU NTY— <br /> Greatn ss grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:O\\-L1Inspect r: CONSTRUCTION <br /> Facility Address: \-50`� F�- <br /> r <br /> Well Address: \\p 0\ kk'• Total Depth: _ <br /> WP# ,k\�Q Well#: Drilling Rig Type: V-\S tc <br /> Soil Boring#: N J n1 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: 6.7 Screen Length From: �p To: 'J,�"� <br /> Driller Onsite: /S0w'C.t.'. Filter Pack From: To: +<7 <br /> Consultant: U" () Bentonite From � <br /> Geologist: Q��,>tJ :_ To: _ <br /> Grout From: 50,.4,. . To: �p� <br /> Public Water System Onsite: IOkYes ❑No COMPLETION ❑ Stove Pipe Christie Box <br /> Domestic Well Onsite: ❑ Yes VkNo casing <br /> If yes, location and distance: height <br /> SAMPLING �}I`� ABOVE-GROUND cmRzaw3ox <br /> Holding Temperature: cowLEriON COMPLETION <br /> Method: Grourd Swfaca <br /> Screening Method: P prat <br /> Verified Chain of Custody: El Yes ❑No ft' <br /> ft. ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No =` <br /> If yes, spoils storage Location:\Sb'I-- <br /> sac5on <br /> Covered: I&Yes ❑No = p..k <br /> If yes, material: >t+ . <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: t 63 fL r <br /> $3 n' <br /> Grout Material: <br /> Gallons of Grout Used: � � MATERIALS/DEVELOPMENT <br /> Casing Type: V\j L <br /> Well Installation ❑Well Destruction Blankt� Feet Screen 15 Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12,5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.535 7 35 70 7 <br /> 40 80 B <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.secehd.com <br />